Factors Affecting the Prognosis of Patients with Acute Cerebrovascular Occlusion with High National Institutes of Health Stroke Scale Scores Treated with SWIM Technology.

Objective: We aimed to explore the factors affecting the prognosis of patients with acute cerebrovascular occlusion with high National Institutes of Health Stroke Scale (NIHSS) scores treated with the SWIM (Solitaire™ stent retriever-assisted thrombectomy with immediate mechanical aspiration) technique using an intracranial support catheter. Methods: A retrospective analysis was conducted in 72 patients with acute cerebrovascular occlusion who underwent SWIM surgery in the Affiliated Hospital of Chengde Medical University in China between January 2020 and June 2022. The patients were divided into a good prognosis group (Modified Rankin Score [mRS] 0 to 2; n = 30) and a poor prognosis group (mRS score 3 to 6; n = 42) on their mRS scores 3 months after surgery. The THRIVE (TICI, hemorrhage, reocclusion, infarction, vessel, and embolism) score at different time points before and after the SWIM procedure and the postoperative revascularization rate were compared in the 2 NIHSS score groups. Univariate and logistic regression analyses were performed to identify the risk factors that affected the prognosis of patients with acute cerebrovascular occlusion treated with the SWIM procedure. Results: The NIHSS score difference at various time points after SWIM surgery in patients with low to moderate NIHSS scores was significantly higher than in patients with high NIHSS scores (P < .05). The postoperative revascularization rate in patients with high NIHSS scores was 74.36%, which was not significantly different from that in patients with low to moderate scores (84.85%; P > .05). The poor prognosis in patients with acute cerebrovascular occlusion after SWIM surgery was related to age, hypertension, NIHSS score, Glasgow Coma Scale (GCS) score, Essen Stroke Risk Score (ESRS), onset-to-treatment time (OTT) and Alberta Collateral Grading Scale (ACGS) score (P < .05). Logistic regression analysis showed that age, admission NIHSS score and ACGS score were independent risk factors that affected the prognosis in patients with acute cerebrovascular occlusion treated with the SWIM procedure (P < .05). Conclusion: The prognosis in patients with acute cerebrovascular occlusion with high NIHSS scores after SWIM surgery was poor. Advanced age, high NIHSS score and ACGS score were independent risk factors that affected the prognosis in patients with acute cerebrovascular occlusion treated with the SWIM procedure. Overall, incorporating these findings into clinical practice promotes personalized approaches, interdisciplinary collaboration and timely interventions to optimize outcomes in patients undergoing the SWIM procedure for acute cerebrovascular occlusion.

[Effect of electroacupuncture invention on activities of PGC-1α/Irisin (FNDC5)/BDNF signaling in cerebral cortex, hippocampus and muscles in focal cerebral ischemic/reperfusion injury rats].

OBJECTIVE: To observe the effect of electroacupuncture(EA) on the expression of peroxisome proliferator-activated receptor gamma coactivators-1-alpha (PGC-1α), Irisin and brain-derived neurotrophic factor (BDNF) in the ischemic peripheral cortex, hippocampus and local skeletal muscle in rats with focal cerebral ischemic/reperfusion injury (CI/RI), so as to explore its underlying mechanism of improving of CI/RI. METHODS: Male SD rats were randomly divided into 3 groups: sham-operation, model and EA (11 rats in each group). The focal CI/RI model was established by middle cerebral artery occlusion (MCAO). EA (2 Hz /15 Hz, 2 to 4 mA) was applied to "Quchi" (LI11) and "Zusanli" (ST36) of the affected side for 20 min, once a day for 7 days. Zea-Longa's score and Balance Beam score were used to evaluate the neurological and motor functions. The infarcted volume of the brain was detected by using 2,3,5-triphenyltetrazolium chloride staining. The expression levels of PGC-1α, fibronectin type III domain-containing protein 5(FNDC5) and BDNF proteins in the ischemic peripheral cortex, hippocampus and local skeletal muscle were detected by Western blot. RESULTS: Compared with the sham-operation group, the Zea-Longa's score, Balance Beam score, percentage of cerebral infarct volume were notably increased (P<0.01), while the expression levels of PGC-1α, FNDC5 and BDNF proteins in the cerebral cortex and hippocampus (not in the local muscle) were significantly down-regulated in the model group (P<0.01, P<0.05). In comparison with the model group, the increase of Zea-Longa's score, Balance Beam score, percentage of cerebral infarct volume, and the decrease of expression levels of PGC-1α, FNDC5 and BDNF proteins in the ischemic peripheral cortex and that of BDNF in the hippocampus were reversed in the EA group (P<0.01, P<0.05). No significant changes were found in the expression levels of hippocampal PGC-1α and FNDC5 proteins in the hippocampus and those of PGC-1α, FNDC5 and BDNF proteins in the local muscle after EA intervention (P>0.05). CONCLUSION: EA can improve neurological and motor functions and reduce cerebral infarction volume in CI/RI rats, which may be related to its functions in activating PGC-1α/Irisin(FNDC5)/BDNF pathway in the cerebral cortex.

Anaesthesia for mechanical thrombectomy: a narrative review.

Stroke is a leading cause of death and disability, and is associated with a huge societal and economic burden. Interventions for the immediate treatment of ischaemic stroke due to large vessel occlusion are dependent on recanalisation of the occluded vessel. Trials have provided evidence supporting the efficacy of mechanical thrombectomy in ischaemic stroke due to large vessel occlusion. This has resulted in changes in management and organisation of stroke care worldwide. Major determinants of effectiveness of thrombectomy include: time between stroke onset and reperfusion; location of occlusion and local collateral perfusion; adequacy of reperfusion; patient age; and stroke severity. The role of anaesthetic technique on outcome remains controversial with published research showing conflicting results. As a result, choice of conscious sedation or general anaesthesia for mechanical thrombectomy is often dependent on individual operator choice or institutional preference. More recent randomised controlled trials have suggested that protocol-driven general anaesthesia is no worse than conscious sedation and may even be associated with better outcomes. These and other studies have highlighted the importance of optimal blood pressure management as a major determinant of patient outcome. Anaesthetic management should be tailored to the individual patient and circumstances. Acute ischaemic stroke is a neurological emergency; clinicians should focus on minimising door-to-groin puncture time and the provision of high-quality periprocedural care with a particular emphasis on the maintenance of an adequate blood pressure.

Gynura procumbens Root Extract Ameliorates Ischemia-Induced Neuronal Damage in the Hippocampal CA1 Region by Reducing Neuroinflammation.

Gynura procumbens has been used in Southeast Asia for the treatment of hypertension, hyperglycemia, and skin problems induced by ultraviolet irradiation. Although considerable studies have reported the biological properties of Gynura procumbens root extract (GPE-R), there are no studies on the effects of GPE-R in brain damages, for example following brain ischemia. In the present study, we screened the neuroprotective effects of GPE-R against ischemic damage and neuroinflammation in the hippocampus based on behavioral, morphological, and biological approaches. Gerbils received oral administration of GPE-R (30 and 300 mg/kg) every day for three weeks and 2 h after the last administration, ischemic surgery was done by occlusion of both common carotid arteries for 5 min. Administration of 300 mg/kg GPE-R significantly reduced ischemia-induced locomotor hyperactivity 1 day after ischemia. Significantly more NeuN-positive neurons were observed in the hippocampal CA1 regions of 300 mg/kg GPE-R-treated animals compared to those in the vehicle-treated group 4 days after ischemia. Administration of GPE-R significantly reduced levels of pro-inflammatory cytokines such as interleukin-1ß, -6, and tumor necrosis factor-α 6 h after ischemia/reperfusion. In addition, activated microglia were significantly decreased in the 300 mg/kg GPE-R-treated group four days after ischemia/reperfusion compared to the vehicle-treated group. These results suggest that GPE-R may be one of the possible agents to protect neurons from ischemic damage by reducing inflammatory responses.

Blood Pressure During Endovascular Treatment Under Conscious Sedation or Local Anesthesia.

OBJECTIVE: To evaluate the role of blood pressure (BP) as mediator of the effect of conscious sedation (CS) compared to local anesthesia (LA) on functional outcome after endovascular treatment (EVT). METHODS: Patients treated in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry centers with CS or LA as preferred anesthetic approach during EVT for ischemic stroke were analyzed. First, we evaluated the effect of CS on area under the threshold (AUT), relative difference between baseline and lowest procedural mean arterial pressure (∆LMAP), and procedural BP trend, compared to LA. Second, we assessed the association between BP and functional outcome (modified Rankin Scale [mRS]) with multivariable regression. Lastly, we evaluated whether BP explained the effect of CS on mRS. RESULTS: In 440 patients with available BP data, patients treated under CS (n = 262) had larger AUTs (median 228 vs 23 mm Hg*min), larger ∆LMAP (median 16% vs 6%), and a more negative BP trend (-0.22 vs -0.08 mm Hg/min) compared to LA (n = 178). Larger ∆LMAP and AUTs were associated with worse mRS (adjusted common odds ratio [acOR] per 10% drop 0.87, 95% confidence interval [CI] 0.78-0.97, and acOR per 300 mm Hg*min 0.89, 95% CI 0.82-0.97). Patients treated under CS had worse mRS compared to LA (acOR 0.59, 95% CI 0.40-0.87) and this association remained when adjusting for ∆LMAP and AUT (acOR 0.62, 95% CI 0.42-0.92). CONCLUSIONS: Large BP drops are associated with worse functional outcome. However, BP drops do not explain the worse outcomes in the CS group.

Local Anesthesia Without Sedation During Thrombectomy for Anterior Circulation Stroke Is Associated With Worse Outcome.

BACKGROUND AND PURPOSE: The best anesthetic management for mechanical thrombectomy of large vessel occlusion strokes is still uncertain and could impact the quality of reperfusion and clinical outcome. We aimed to compare the efficacy and safety outcomes between local anesthesia (LA) and conscious sedation in a large cohort of acute ischemic stroke patients with anterior circulation large vessel occlusion strokes treated with mechanical thrombectomy in current, everyday clinical practice. METHODS: Patients undergoing mechanical thrombectomy for anterior large vessel occlusion strokes at 4 comprehensive stroke centers in France between January 1, 2018, and December 31, 2018, were pooled from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. Intention-to-treat and per-protocol analyses were used. RESULTS: Among the included 1034 patients, 762 were included in the conscious sedation group and 272 were included in the LA group. In the propensity score matched cohort, the rate of favorable outcome (90-day modified Rankin Scale score 0-2) was significantly lower in the LA group than in the conscious sedation group (40.0% versus 52.0%, matched relative risk=0.76 [95% CI, 0.60-0.97]), as well as the rate of successful reperfusion (modified Thrombolysis in Cerebral Infarction grade 2b-3; 76.6% versus 87.1%; matched relative risk=0.88 [95% CI, 0.79-0.98]). There was no difference in procedure time between the 2 groups. In the inverse probability of treatment weighting-propensity score-adjusted cohort, similar significant differences were found for favorable outcomes and successful reperfusion. In inverse probability of treatment weighting-propensity score-adjusted cohort, a higher rate of 90-day mortality and a lower parenchymal hematoma were observed after LA. The sensitivity analysis restricted to our per-protocol sample provided similar results in the matched- and inverse probability of treatment weighting-propensity cohorts. CONCLUSIONS: In the Endovascular Treatment in Ischemic Stroke registry mainly included patients in early time window (<6 hours), LA was associated with lower odds of favorable outcome, successful reperfusion, and higher odds of mortality compared with conscious sedation for mechanical thrombectomy of large vessel occlusion.

A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes.

BACKGROUND: Mechanical thrombectomy (MT) for acute ischemic stroke can be performed under local anesthesia, with or without conscious sedation (CS), or under general anesthesia (GA). The hemodynamic consequence of anesthetic drugs may explain why GA may be associated with worse outcomes. We evaluated the association between hypotension duration during MT and the 90 day functional outcome under both anesthetic regimens. METHODS: Patients were included in this retrospective study if they had an ischemic stroke treated by MT under GA or CS. The main exposure variable was the time below 90% of the reference value of arterial pressure measured before MT. The primary outcome was poor functional outcome defined as a 90 day modified Rankin Score ≥3. RESULTS: 371 patients were included in the study. GA was performed in 42%. A linear association between the duration of arterial hypotension and outcome was observed. The odds ratio for poor functional outcome of 10 min under 90% of the baseline mean arterial pressure was 1.13 (95% CI 1.06 to 1.21) without adjustment and 1.11 (95% CI 1.02 to 1.21) after adjustment for confounding factors. The functional outcome was poorer for patients treated under GA compared with CS, but the association with the depth of hypotension remained similar under both conditions. CONCLUSION: In this study, we observed a linear association between the duration of hypotension during MT and the functional outcome at 90 days. An aggressive and personalized strategy for the treatment of hypotension should be considered. Further trials should be conducted to address this question.

Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry.

OBJECTIVE: To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome. METHODS: Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center. RESULTS: A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60%), GA in 381 (28%), and CS in 174 (13%) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cORadj 0.75; 95% confidence interval [CI] 0.58-0.97; CS cORadj 0.45; 95% CI 0.33-0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95% CI 0.42-0.87). CONCLUSIONS: LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.

Endovascular Clot Retrieval by Hub-and-Spoke Service Delivery is Feasible Compared with Direct-to-Mothership.

BACKGROUND: Endovascular clot retrieval (ECR) improves outcomes for acute ischaemic stroke with large artery occlusion. However, the provision of ECR requires resource-intensive comprehensive stroke centres (CSC), which are impractical to establish in regional hospitals. An alternative is a "hub-and-spoke" model, whereby ischaemic strokes are triaged at the regional primary centres and where eligible, transferred to a CSC. We aimed to compare the outcomes of patients directly admitted to a CSC with patients treated in the "hub-and-spoke" model. We hypothesize that there are no significant differences in clinical outcomes between the 2 systems. METHODS: We included patients undergoing ECR at a CSC. Patients were categorised into 2 groups; the first group included patients directly admitted to the CSC and the second group included patients in the "hub-and-spoke" model. Good clinical outcome was defined as modified Rankin Scale 0-2 and the difference between the 2 groups was tested by logistic regression. RESULTS: Of 178 patients, 50 (28%) presented directly to CSC and 128 (72%) were transferred from a referring hospital. The median age was 70 (interquartile range 58-77) and 61% were male. Thrombolysis in ischaemic cerebral-infarction 2b/3 recanalisation was achieved in 79% of patients. Of the direct group, 63% (95% CI 48-77%) achieved good clinical outcomes compared to 52% (95% CI 43-61%) in the "hub-and-spoke" group (p = 0.233). CONCLUSION: This state-wide service model demonstrates comparable clinical outcomes to that described in clinical trials. We found no significant difference in outcome between patients directly admitted to CSC and those with "hub-and-spoke" service delivery.

Unilateral Tuberothalamic Artery Ischemia Caused by Pituitary Apoplexy.

BACKGROUND AND IMPORTANCE: Pituitary apoplexy (PA) occasionally occurs in patients with pituitary adenoma and may cause severe functional deficits. Headache, pituitary insufficiency, visual impairment, and cranial nerve palsies are the most frequent symptoms in patients with PA. Secondary cerebral ischemia develops in only a limited number of PA patients. Two pathogenic mechanisms were previously proposed. One states that ischemia may be due to major vessel encasement or to vessel compression, as a result of extended tumor growth. The second states that cerebral vasospasm following PA may cause ischemia. We present another mechanism. After PA, a sudden increase in suprasellar tumor volume can lead to compression of perforating arteries causing hypoperfusion and subsequent focal ischemia of the thalamus, basal ganglia, and internal capsule. CLINICAL PRESENTATION: We present the case of a 75-year-old woman who, after having PA, developed cerebral ischemia in the territory of the left anterior thalamus and internal capsule that is primarily supplied by the tuberothalamic artery. Computed tomography and magnetic resonance imaging are used to describe how mechanical compression of the tuberothalamic artery caused this rare phenomenon. The recent literature, vascular anatomy, and pathophysiologic aspects of PA are discussed. CONCLUSION: PA can lead to compression of perforating arteries, for example, the tuberothalamic artery supplying the thalamus or lenticulostriate region, and thus cause hypoperfusion and subsequent focal cerebral ischemia. This may occur when perforating cerebral arteries are affected and compressed by the sudden increase in tumor volume due to hemorrhage or tumor swelling.

Anesthesia-Related Outcomes for Endovascular Stroke Revascularization: A Systematic Review and Meta-Analysis.

BACKGROUND AND PURPOSE: There is currently controversy on the ideal anesthesia strategy during mechanical thrombectomy for acute ischemic stroke. We performed a systematic review and meta-analysis of studies comparing clinical and angiographic outcomes of patients undergoing general anesthesia (GA group) and those receiving either local anesthesia or conscious sedation (non-GA group). METHODS: A literature search on anesthesia and endovascular treatment of acute ischemic stroke was performed. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome at 90 days (modified Rankin Score≤2), symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, and time to groin puncture. RESULTS: Twenty-two studies (3 randomized controlled trials and 19 observational studies), including 4716 patients (1819 GA and 2897 non-GA) were included. In the nonadjusted analysis, patients in the GA group had higher odds of death (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.66-2.45) and respiratory complications (OR, 1.70; 95% CI, 1.22-2.37) and lower odds of good functional outcome (OR, 0.58; 95% CI, 0.48-0.64) compared with the non-GA group. There was no difference in procedure time between the 2 primary comparison groups. When adjusting for baseline National Institutes of Health Stroke Scale, GA was still associated with lower odds of good functional outcome (OR, 0.59; 95% CI, 0.29-0.94). When considering studies performed in the stent-retriever/aspiration era, there was no significant difference in good neurological outcome rates (OR, 0.84; 95% CI, 0.67-1.06). CONCLUSIONS: Acute ischemic stroke patients undergoing intra-arterial therapy may have worse outcomes when treated with GA as compared with conscious sedation/local anesthesia. However, major limitations of current evidence (ie, retrospective studies and selection bias) indicate a need for adequately powered, multicenter randomized controlled trials to answer this question.

Effect of brain functional recovery decoction on expression of vascular endothelial growth factor and Ang-1 protein in a rat cerebral ischemia reperfusion model.

OBJECTIVE: To investigate the effect of brain functional recovery decoction (BFRD) on expression of vascular endothelial growth factor (VEGF) and angiopoietin-1 (Ang-1) protein in rats with cerebral ischemia reperfusion injury, and to explore the mechanism of action of BFRD. METHODS: Using the suture-occlusion method, a Wistar rat model of focal cerebral ischemia reperfusion was established. The rats were randomly divided into treatment group, model group, and sham operation group. The treatment group was administered BFRD. In situ hybridization was used to detect VEGF mRNA expression. Immunohistochemistry was used to observe expression of Ang-1 protein. RESULTS: VEGF mRNA expression was greater in the model group compared with the sham operation group (P < 0.05); Ang-1 protein expression was more obvious in the treatment group than the model group (P < 0.05). CONCLUSION: BFRD promoted VEGF mRNA and Ang-1 protein expression in the brains of rats with cerebral ischemia, suggesting increased angiogenesis.

PROTECTIVE EFFECTS OF ETHYL ACETATE EXTRACTION FROM GASTRODIA ELATA BLUME ON BLOOD-BRAIN BARRIER IN FOCAL CEREBRAL ISCHEMIA REPERFUSION.

BACKGROUND: Damage of the blood brain barrier (BBB) during the process of cerebral ischemic injury is a key factor which influences the therapeutic efficacy to the cerebral ischemic injury. The present study was designed to verify the mechanisms underlying the protective effects of the ethyl acetate (EtOAc) extraction from Gastrodia elata Blume (GEB) on the BBB by developing a model of cerebral ischemia-reperfusion in rats. MATERIAL AND METHODS: MCAO/R model in rats was developed through a thread embolism method. The neurological scales, the moisture and the evans blue (EB) contents of brains were detected. Meanwhile, the release of nitric oxide (NO) and activities of NO synthase (NOS) in brain tissues were measured. Western blotting analyses were also performed to assess the protein expressions of AQP-4, Occludin and Claudin-5 in brain tissue. RESULTS: After rats were pretreated with different concentrations of EtOAc extractions from GEB, the neurologic scores, the EB contents in the brain tissues and the moisture of the brains were significantly decreased. Meanwhile, the release of NO, the activities of nNOS and iNOS were notably inhibited. Furthemore, the protein expression of AQP-4 was markedly decreased, but the protein expressions of -5 and Occludin were significantly increased. CONCLUSION: the EtOAc extracts of GEB may decrease the permeability of BBB when focal cerebral ischemia occurs. The inhibition of the NOS pathways, the attenuation of the protein expression of AQP-4 and the enhancement of the expressions of the tight junction proteins may contribute to the protective effects of the EtOAc extracts from GEB on BBB.

[Effect of Electroacupuncture Combined with Rehabilitation Training on Neurological Function and Expression of Neuronal Growth Associated Protein 43 and Synaptophysin in Rats with Focal Cerebral Ischemia/Reperfusion Injury].

OBJECTIVE: To observe the effect of electroacupuncture (EA) combined with rehabilitation training on motor function and expression of neuronal growth associated protein 43 (GAP-43) and synaptophysin (SYP) in hippocampal CA 3 region in rats with focal cerebral ischemia/reperfusion injury (CI/RI). METHODS: A total of 46 SD rats were randomized into normal control, CI/RI model, rehabilitation training (RT), paralysis-side (unilateral)-EA+RT, and bilateral-EA+RT groups (n=6 in the normal control group, and n=10 in each of the other group). The CI/RI model was established by occlusion of the middle cerebral artery (MCAO) and reperfusion. EA (5 Hz/10 Hz, 2 mA) was applied to the unilateral "Quchi" (LI 11) and "Housanli" (ST 36) on the affected side or bilateral LI 11 and ST 36 for 30 min, once daily for two weeks except the Sunday. The neurological deficit severity (Zea Longa score) was assessed 24 h, 7 and 14 days after modeling. The immunoactivity of GAP-43 and SYP in the CA 3 region of the hippocampus was detected using immunohistochemistry. Pathological changes of the prefrontal cortex was observed after H.E. staining. RESULTS: Following modeling, the neurological deficit scores of the model, RT, unilateral-EA+RT and bilateral-EA+RT groups were gradually decreased, and were significantly lower on day 7 and 14 in the bilateral-EA+RT group and on day 14 in the unilateral-EA+RT group than in the model group (P<0.05). The effect of the bilateral-EA+RT group was obviously superior to those of both RT and unilateral EA+RT groups in improving neurological function (P<0.05). Results of immunohistochemical staining displayed that the expression levels of GAP-43 and SYP in the CA 3 region of hippocampus were significantly up-regulated in the model group than in the normal control group (P<0.05), and further obviously up-regulated in both unilateral-and bilateral-EA+RT groups (P<0.05). No significant changes of GAP-43 and SYP protein expression in the RT group compared with the model group (P>0.05), and the expression levels of GAP-43 and SYP protein in the bilateral-EA+RT were significantly higher than those in the unilateral EA+RT group (P<0.05). H.E. staining showed that the ischemic injury of cells (neuronal apoptosis and enlargement of intercellular space) of the prefrontal cortex was relatively milder in the EA+RT groups. CONCLUSIONS: EA plus RT can promote the recovery of motor function in CI/RI rats, which may be associated with its function in increasing the expression of GAP-43 and SYP in hippocampal CA 3 region. The effects of bilateral-EA+RT is obviously better than those of unilateral EA+RT.

[Research progress of acupuncture for cerebral ischemia reperfusion injury in recent 10 years].

By searching relevant data from the PubMed database, Chinese National Knowledge Infrastructure (CNKI) database and Wanfang database, a comprehensive analysis and review regarding acupuncture for cerebral ischemia reperfusion injury (CIRI) in recent 10 years were performed. The results showed that acupuncture could inhibit the inflammatory reaction, reduce oxidative stress injury, restrain brain edema formation, inhibit apoptosis, promote neural and vascular regeneration, etc. Acupuncture methods used included electroacupuncture, scalp acupuncture, eye acupuncture and "consciousness-restoring resuscitation needling", etc. The existing problem was that the intervention action of acupuncture was mainly focused on inhibiting inflammatory reaction and oxidative stress injury, and the study on apoptosis and neural and vascular regeneration was needed. It is suggested that from the aspect of multiple target points, the intervention mechanism of acupuncture for CIRI should be systemically studied in the future, which could provide new idea for clinical diagnosis and treatment on ischemic cerebrovascular diseases.

[Effect of Sailuotong capsule on mitochondrial dynamics in focal cerebral ischemia/reperfusion rats].

To observe the protective effect and mechanism of Sailuotong capsule in focal cerebral ischemia/reperfusion. The 90 min middle cerebral artery occlusion (MCAO) reperfusion model was established. The expressions of dynamin-related protein 1 ( Drp1) and optic atrophy 1 (Opa1) were tested by Western blot. The transmission electron microscope was used to observe the changes in the mitochondrial ultra-structure. The pathological morphological changes were observed through the HE staining. The immunohistochemical method was used to test Drp1 and Opa1 expressions. Sailuotong capsule (33, 16.5 mg x kg(-1), ig) can inhibit the abnormal mitochondrial fission and fusion in the cortical area on the ischemia side and the mitochondrial fission gene expression and promote the mitochondrial fusion gene Opa1 expression, so as to alleviate the energy metabolism disorder caused by ischemia/reperfusion. Sailuotong capsule can inhibit the abnormal mitochondrial dynamics in peri-ischemic regions and maintain the normal morphology of mitochondria, which may be the mechanism of Sailuotong capsule in promoting the self-recovery function in the ischemic brain region.

[Effects of Acupuncture Stimulation on Dynamic Changes of Cerebral TNF-α and C-reaction Protein Levels in Cerebral Ischemia-reperfusion Rats].

OBJECTIVE: To observe the influence of "Tong Du Tiao Shen" (Governor-Vessel-Dredging and Mental Activity Regulating) acupuncture method on dynamic changes of cerebral TNF-α and C-reaction protein (CRP) levels in focal cerebral ischemia-reperfusion (CI/R) rats, so as to master the optimal time point of acupuncture therapy for cerebral infarction. Methods A total of 72 adult male Wistar rats were randomly divided into blank control, sham-operation, model and acupuncture groups which were further divided into 6 h, 24 h and 48 h subgroups (n 6 in each subgroup) . The CI/R model was established by occlusion of the middle cerebral artery. Acupuncture stimulation of "Baihui" (GV 20), "Fengfu" (GV 16) and "Dazhui" (GV 14) was conducted for 30 min. Neurological deficit symptoms were assessed with the Zea-Longa neurological deficit score and TNF-α and CRP contents in the brain tissue were detected using double sandwich ABC-ELISA method. RESULTS: In comparison with the model group, the Zea-Longa neurological deficit score was significantly decreased in the acupuncture group (P<0. 01). Cerebral TNF-α and CRP levels at time-points of 6 h, 24 h and 48 h after CI/R were significantly increased in the model group than in both control and sham groups (P<0. 01). In the acupuncture group, cerebral TNF-α and CRP levels were obviously lower than those of the model group (P<0. 01). CONCLUSION: Manual acupuncture stimulation of GV 20, GV 16 and GV 14 can relieve neurological deficit function in CI/R rats, which may be related to its function in suppressing TNF-α and CRP levels.

[Effects of electroacupuncture preconditioning on expression of nitric oxide synthase and glial fibrillary acidic protein in cortex of focal cerebral ischemia-reperfusion rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) preconditioning on the expression of neuronal nitric oxide synthase (nNOS), inducible nitric synthase (iNOS) and glial fibrilliary acidic protein (GFAP) in the cortex of focal cerebral ischemia-reperfusion (CI/R) rats so as to explore its underlying mechanism in the protection of ischemic cerebral tissue. METHODS: Twenty-four Sprague-Dawley rats were randomized into sham operation (sham), model, and EA preconditioning groups (n = 8 in each group). The CI/R model was induced by intraluminal middle cerebral artery occlusion .(MCAO) with a nylon monofilament suture. Before modeling, EA (2 Hz/15 Hz, 3 V) was applied to "Baihui"(GV 20) and "Dazhui"(GV 14) for 30 min, once daily for 7 consecutive days. The neurologic impairment score was assessed by using Longa standards and the survival number of neurons in the local ischemic cerebral cortex was determined after Nissl staining, and the expression of nNOS, iNOS and GFAP in the cerebral cortex was detected using immunohistochemistry. RESULTS: Compared with the sham operation group, the neurological deficit score of the rats in the model group was significantly increased (P < 0.01), and the number of survival neurons of the ischemic cortex was obviously decreased (P < 0.01), and the expression levels of nNOS, iNOS and GFAP were significantly increased in the model group (P < 0.01). In the EA preconditioning group , the neurological deficit score, the expression levels of nNOS and iNOS were significantly down-regulated (P < 0.01), while the number of the survival neurons and GFAP expression level in the ischemic cerebral cortex were obviously higher in the EA preconditioning group in compared with the model group (P < 0.01). CONCLUSION: EA preconditioning can protect the ischemic cerebral cortex tissue from injury in CI/R rats, which may be related to its effects in down-regulating the expression of nNOS and iNOS, and up-regulating the expression of GFAP.

[The impact of different duration of EA-pretreatment on expression of MMP-9 and VEGF in blood-brain barrier in rats with cerebral ischemia-reperfusion injury].

OBJECTIVE: To observe the impact of preconditioning of EA stimulation of "Baihui" (GV 20) and "Shuigou" (GV 26) in different duration on expression of matrix metalloproteinase (MMP)-9 and vascular endothelial growth factor (VEGF) in blood-brain barrier (BBB) tissues in rats with cerebral ischemia-reperfusion injury (CI/RI). METHODS: Sixty-four male SD rats were randomly allocated to sham-operation (sham), model, EA-pretreatment 7 days (pre-t-7 d) and EA-pre-t-15 d groups (16 rats/group, 8 rats for immunohistochemistry and 8 for RT-PCR). The CI/RI model was established by occlusion of the middle cerebral artery for 90 min and reperfusion. EA (2 Hz/15 Hz, 1 mA) was applied to GV 20 and GV 26 for 30 min, once daily for 7 days and 15 days respectively before modeling. Immunohistochemical staining and fluorescence quantitative RT-PCR were employed to detect the expression of MMP-9 protein, MMP-9 mRNA and VEGF mRNA in the BBB tissues (choroid plexus). RESULTS: Compared with the sham group, the number of MMP-9 immuno-reaction positive cells, and the expression of MMP-9 mRNA and VEGF mRNA in the model group were significantly increased (P<0.001), while compared with the model group, the number of MMP-9 positive cells, and expression levels of MMP-9 mRNA and VEGF mRNA in the EA-pre-t-7 d and EA-pre-t-15 d groups were significantly reduced (P<0.01), and the effects of EA-pre-t-15 d were markedly superior to those of EA-pre-t-7 d (P<0.01, P<0.05). CONCLUSION: EA-pretreatment of GV 20 and GV 26 can effectively restrain CI/RI-induced increase of expression of MMP-9 protein, MMP-9 mRNA and VEGF mRNA in blood-brain barrier in CI/RI rats, which may contribute to its protective effect of ischemic cerebral tissue. Longer EA-pretreatment is relatively better.